HC Deb 09 March 1950 vol 472 cc599-608

Motion made, and Question proposed, "That this House do now adjourn."— [Mr. Popplewell.]

10.15 p.m.

Mr. Rankin (Glasgow, Tradeston)

desire to call the attention of the House to another of the grave issues that face us today. I refer to the problem of tuberculosis in Scotland. I observe from today's issue of the "Glasgow Herald" that a Committee of the British Medical Association has been considering the treatment of this disease at a conference in Edinburgh. They charge my hon. Friend's Department with complacency in their approach to the solution of this problem. Lacking the facts on which the statement is based, I can make no comment on the charge, but it is a serious one and I trust that some reply to it may be forthcoming tonight.

We are also informed that, according to experts, if 100 trained nurses could be obtained for the treatment of tuberculosis, about 1,000 beds could be made available, thus breaking the back of this problem in Scotland. If the solution is as simple as that, 35,000 sufferers in Scotland, of whom only 4,000 are in hospital or isolated, will look forward to the future with a hope which I trust will not be shattered. Perhaps my hon. Friend may have some comment to offer on that aspect of the matter.

I do not desire tonight to cover ground which is already familiar. The facts are fairly well known, and they have been stated frequently in Debate in the House, on Adjournment Motions and also in the Scottish Grand Committee. It is action that is wanted now, and I want to remind my hon. Friend that a committee was appointed from the National Health Services Council in July, 1948, that is, one and three-quarter years ago, to inquire into the reasons for the continued high incidence and mortality rates of tuberculosis in Scotland. I should like to ask whether my hon. Friend has any- thing to tell us tonight about the deliberations of that committee. Is the report completed yet? Is it nearing completion? Is it going to indicate any lines along which a vigorous attack may be made on this scourge? Can my hon. Friend even tell us tonight whether there is any hope emerging from the committee's deliberations?

I should like to refer to one aspect of this disease, which in my estimation has not received sufficient public attention, namely, the high mortality rate among young women, especially in the most fertile period of their lives. In the age group from 15 to 25, the mortality rate from tuberculosis has now reached a new high level. It is 1.42 per thousand of the population. I think that is a higher figure than has ever been reached before. In the age group 25–35, the mortality rate in 1939 was 74.

The last figure which I obtained was for 1947, and then it was 1.47. It had nearly doubled in a period of eight years. We have to note that the corresponding figures on the male side are not nearly so bad. We have been content, perhaps too long content, to regard the lack of proper housing as being one of the fundamental causes, if not the fundamental cause, of the continuance of tuberculosis in our midst. But in view of the figures I have quoted, I am prompted to ask whether there is any other cause to which we have not paid sufficient attention.

In the case of these young women, we must recognise that in the period from 15 to 25 great glandular changes are occurring in their bodies which increase their nutritional demands. I should like to remind my hon. Friend that for chronic sufferers from tuberculosis, special or extra diet is afforded. Why not, then, an extra diet for the female adolescents in the years when the seeds of the disease are most likely to be sown? Surely, if for those who are chronic sufferers, and who, in many cases, are old, we can afford extra diet as a form of treatment, we could do the same for those who are young, whose lives are still before them, and who are of tremendous importance to the continuance of the race. Could we not afford them extra diet such as is afforded to those who are old?

There are one or two other suggestions on the preventive side that I should like to offer. The first is the possibility of segregation in housing. Today, many of our local authorities assign 10 per cent. of their new houses to those suffering from tuberculosis. What we are doing is to place in many of our new housing schemes people suffering from the disease. I know that segregation is not an ideal solution, but in the treatment of the disease, segregation must occur at some stage. It might be possible for us to explore the possibility of segregation in our new housing schemes; and of separating the proportion allotted to sufferers from tuberculosis to another part of the country, thereby, perhaps, laying the foundations in Scotland of a village similar to Papworth which exists in England.

Mr. Carmichael (Glasgow, Bridgtown)

I am sorry to interrupt my hon. Friend, but is he suggesting that we should segregate into an area of their own people suffering from tuberculosis?

Mr. Rankin

Yes. I am sorry, but it is difficult to explore this matter in an Adjournment Debate. I am throwing out the suggestion because those of us who have read the history of Papworth Village—with the rehabilitation that has accompanied the creation of that community—and who keep in mind the fact that when in ordinary industry an individual is discovered to be suffering from tuberculosis there is a tendency to isolate him from those working with him, think it might be one way of helping to combat the disease. If that suggestion could be carried out along the lines I have indicated, we might see an experiment growing from it in Scotland similar to the one that has proved so successful in England.

Most of us are subject to ordinary common anti-social habits like sneezing and coughing and, perhaps, in some cases spitting. I do not suggest that applies to any individual in this House, but public authorities make spitting a punishable offence. We all know the discomfort of having people in public places who indulge in uncontrolled sneezing and coughing. I suggest it might be possible to use the cinema, just as it was used during the election, to show the incidence of tuberculosis from the lack of control over these anti-social habits.

Thirdly, I should like to draw my hon. Friend's attention to the fact that the Scottish section of the National Association for the Prevention of Tuberculosis has long been trying to get the regional hospital board to set up a permanent tuberculosis committee so that full-time attention might be given to the treatment of this disease. I should like to ask what success has attended their efforts in getting the regional board to establish this full-time committee. I am sure we all agree on the need for a vigorous and sustained crusade on this, the chief of our killing diseases. It lays its cold and clammy hand mostly on the young. That is the most appalling aspect of this scourge. I hope my hon. Friend, when he replies, will have encouraging words to give to the House.

10.28 p.m.

The Joint Under-Secretary of State for Scotland (Mr. Thomas Fraser)

My hon. Friend is to be congratulated upon raising this most important matter for discussion so early in the new Parliament. Tuberculosis, is of course, the least satisfactory feature of the health of Scotland. Despite the closest study by Scottish experts, the reason why Scotland is far worse than most other Western European countries since the war remains obscure.

My hon. Friend has very properly called attention to the committee that was invited to investigate the reasons for the high incidence of tuberculosis some 18 months or more ago. Hon. Members from Scottish constituencies who listened to, or participated in, our discussions last summer will remember that hon. Members in all parts of the House were most concerned that the committee had not reported within a year. At that time we said that the committee must not be pressed to give ill-considered views or recommendations to my right hon. Friend and that they must be allowed to do the job thoroughly. The committee has not yet reported, but I understand it is on the point of doing so. We expect to hear from them at a very early date. Many of the suggestions made or the questions asked by my hon. Friend are matters I might be better able to deal with when we get the committee's report.

There are perhaps one or two facts I can give. One new fact which I should report tonight—and an encouraging one— is that for 1949 the Scottish death rate from respiratory tuberculosis was 10 per cent. below the 1948 figure, and, at 59 per 100,000 of the population, was the lowest since 1939. That is encouraging, because we have been most alarmed to see the Scottish rate still rising when the rate was going down in most other countries in Western Europe. When we add non-respiratory tuberculosis to these figures, the total death rate of 67 per 100,000 of population is the lowest ever recorded. So we are now moving in the right direction. These figures are encouraging, but they are no justification for rejoicing. We have still a long way to go before we can be satisfied.

My hon. Friend the Member for Tradeston (Mr. Rankin) gave some figures about deaths among females in certain age groups. I have not been able to check them. I do not think they were very recent figures. I think they were the figures for 1947. We have not yet been able to get a break-up into sexes and age groups of the 1949 figures. I should also tell the House, however, that although the deaths went down last year notifications went up, but firm figures are not yet available. These increased notifications were no doubt due partly to better case-finding methods.

It is clear that in most cases patients are having the disease diagnosed at an earlier stage than was done before the war. We shall continue to take cases at the earliest stage, and to this end the number of mass radiography units in Scotland is being increased. Within the next few weeks the total of these mass radiography units in operation will be seven. With increased notifications and longer periods of hospital treatment, there has been a tendency for the waiting lists to grow longer. In West Scotland, where tuberculosis was worst, the waiting list is growing less, though the waiting lists elsewhere are growing longer in the areas where tuberculosis is not so widespread. This improvement in the West is largely due to the energetic efforts of the Western Regional Hospital Board in providing additional beds. In the last 18 months the Board has diverted some 250 beds, mostly in infectious diseases hospitals. This work is continuing, but not so rapidly as it would if more nurses could be recruited for tuberculosis cases. Another develop- ment is for the use of lightly-staffed accommodation for patients able to look after their own needs. The Western Regional Hospital Board, with other boards, has been pursuing these different lines of attack.

My hon. Friend asked whether I could comment upon statements in the Press today on a conference held in Edinburgh yesterday. I am not sure that it would be wise of me to enter into criticism just now of statements made at the conference; but I have taken the opportunity, since I saw this Press report today, of consulting Departmental officials. They have not had time to go into this matter fully, but they tell me that the statements contained in the report are not a little misleading. If I may quote, one of the speakers who is given much "copy" in the Press is reported to have said: If 100 trained nurses working together with part-time and part-trained nurses could be got, 1,000 beds could be made available in Scotland. As my hon. Friend says, this same doctor went on to say that this would break the back of the problem. The impression is created that if 100 trained nurses could be got we would get additional beds. But that is not so. This doctor has not even said so. He has said: together with part-time and part-trained nurses. But how many? We do not know. Reference is made in this report to the number of nurses in sanatoria.

Mr. McAllister (Rutherglen)

Can the hon. Gentleman say how many unfilled beds there are in sanatoria?

Mr. Fraser

I would prefer not to go into those details, but to try to give a general picture. This Press report gives the impression that 100 trained nurses would give accommodation for another thousand patients, and that simply is not so. We have to have the part-time and part-trained nurses. The other thing is that in this report one finds reference to the number of nurses in the sanatoria. It states that the number has gone up only by 16, and that implies that our recruitment programme has met with no success at all; but the truth is that our sanatoria are working almost to capacity and to recruit more nurses for the sanatoria would not necessarily mean more people being treated in those sanatoria.

As I said a few moments ago, the Western Regional Hospital Board has dealt with the problem in different ways. Among those different ways is the fact that more than 250 beds have been transferred to tuberculosis treatment, many from isolation hospitals. No account is taken of this fact in the treatment of tuberculosis in the analysis dealt with at the conference and reported in the Press. I do not think that I should go farther than make this comment; I do not want to belittle anything which any doctor has said in a conference at Edinburgh before the Department has had more opportunity of looking into the whole question.

Mr. Henderson Stewart (Fife, East)

It is stated that the Department points to the increase of the number of nurses and that increase amounted in a whole year to only 16. Is that correct?

Mr. Fraser

No, I have just said that that is not the complete picture. That reference is only to nurses in the sanatoria, which, as I have said, are working almost to capacity. There is no account taken of the number of nurses necessary to staff the 250 beds which I have referred to, made available by the Western Regional Hospital Board. That is certainly one of the facts which appears to have been overlooked. But I do not want to say more until the Department of Health has had more opportunity of considering the matter.

Let me make it quite clear that the great need is for nurses. I am glad to be able to tell the House that recruitment is steadily improving and that when the revised salary scales were negotiated further consideration was given to the need for tuberculosis nurses. It will be recalled that when we discussed this matter last summer, we were pressed from all sides of the House to give financial encouragement to the nurses in tuberculosis centres. When these salary scales were negotiated, further consideration was given to this exceptional need and a further financial inducement was negotiated. It takes the form, as some hon. Members may know, of £30 for each completed year, and for student nurses an allowance of £40 after two years in a respiratory tuberculosis ward.

My hon. Friend who raised this question dealt with this matter of housing priority for tuberculosis patients. Most of our local authorities do already give some preference to applicants who are active tuberculosis patients. He wondered whether it is a good thing to put those active tuberculosis cases into all our new housing schemes and suggested that there should be some segregation. My hon. Friend was not easy in his own mind when making this proposal, and I suggest to him that if we were to segregate those active tuberculosis cases in one corner of a housing scheme, or in one separate housing scheme, that would probably be the worst possible thing psychologically. I feel sure that, on reflection, he will agree with me. We would find it exceedingly difficult to get people to live in a colony, for that is what it would be—a colony of tuberculosis sufferers. No one would want to go there.

He also mentioned that there was the problem of sneezing and coughing in cinemas and other public places. It may well be that there has been a spreading of disease, and it was suggested that film publicity might be used to discourage people from a dirty habit.

Mr. Rankin

When the hon. Gentleman dealt with the psychological difficulty, which I admit, has he heard of Switzerland, and the eagerness with which people seek special treatment?

Mr. Fraser

Those people want to go for special treatment, but they do not want to take their wives and families and live in a colony all their life. But I shall certainly pass on the suggestion about the possibility of getting some film publicity to discourage sneezing and coughing in cinemas and other public places. It was done during the war, but not widely—when we had the "Coughs and sneezes spread diseases" campaign—and it may well be that we should repeat it.

We are already working on more radical measures to prevent the disease. As an initial step, B.C.G. vaccines are to be offered to nurses and medical students, and in addition local authorities have been instructed to offer them to known contacts with tuberculosis cases. At present it is necessary to obtain the vaccine from abroad. Production difficulties have caused an unfortunate hitch. However, experts from this country have returned from a visit to Denmark, from which country we hope to get vaccine. The difficulties have been discussed on the spot and we are hopeful that supplies will become available shortly. We still regard the treatment of tuberculosis as number one priority among Scotland's health problems. We shall continue to deal with the problem as such, and I hope we will not be thought guilty of complacency.

The Question having been proposed after Ten o'Clock, and the Debate having continued for half an hour, Mr. DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at Seventeen minutes to Eleven o'Clock.